Provider Demographics
NPI:1972584647
Name:CHEVEREZ, PEDRO (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:CHEVEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 CALLE MALAGUETA
Mailing Address - Street 2:URB CIUDAD JARDIN III
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-4820
Mailing Address - Country:US
Mailing Address - Phone:787-799-4116
Mailing Address - Fax:787-730-1403
Practice Address - Street 1:137 CALLE MALAGUETA
Practice Address - Street 2:URB CIUDAD JARDIN III
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-4820
Practice Address - Country:US
Practice Address - Phone:787-799-4116
Practice Address - Fax:787-730-1403
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1772122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR41654OtherTRIPLE S